专题研究(Monographic Study)

“三线一平面”解剖标记在腹腔镜胆道结石手术中的应用

Published at: 2016年第25卷第8期

汪雷 1 , 侯辉 1 , 吴春利 1 , 喻宗繁 1 , 万圣云 1
1 安徽医科大学第二附属医院 普通外科,安徽 合肥 230601
通讯作者 辉 侯 Email: hui0402@hotmail.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2016.08.002
基金:
安徽医科大学第二附属医院“火花计划”资助项目 2015-2017

摘要

目的:探讨“三线一平面”肝外胆道定位标记在腹腔镜治疗胆道结石中的应用价值。方法:自2014年1月—2015年12月安徽医科大学第二附属医院普外一科连续实施腹腔镜胆囊手术445例,腹腔镜胆管探查手术70例,术中均采取“三线一平面(十二指肠球部上缘弧线;肝右后叶肝蒂弧形切迹线;肝总管及胆总管正中线;肝门板平面)”作为术中的肝外胆道的解剖定位标记。结果:全组未发生胆管损伤及手术死亡。腹腔镜胆囊手术无中转开腹者,腹腔镜胆管探查手术中转开腹1例(1.4%),术后胆瘘2例(2.9%)经保守治疗治愈。所有患者恢复良好。结论:以“三线一平面”为导向的胆道解剖方法可以预防腹腔镜胆道结石术中胆管和血管损伤,值得推广应用。


Application of “three lines and one plane” as anatomic landmarks in laparoscopic surgery for bile duct stones

Abstract

Objective: To investigate the application value of using “three lines and one plane” as landmarks for extrahepatic bile ducts in laparoscopic surgery for bile duct stones. Methods: From January 2014 to December 2015, 445 cases of laparoscopic cholecystectomy and 70 cases of laparoscopic common bile duct exploration consecutively performed in the First Department of General Surgery of the Second Affiliated Hospital of Anhui Medical University. “Three lines and one plane” which refers to the upper curve of the duodenal bulb, the arc incisure curve of the hepatic pedicle of the right posterior lobe, the middle line between the common hepatic duct and the common bile duct and the plane of the hilar plate, were used as anatomical landmarks for extrahepatic bile ducts during operation in all patients. Results: No bile duct injury or surgical death occurred in any of the entire group of patients. No open surgical conversion was needed in patients undergoing laparoscopic cholecystectomy, while in those undergoing laparoscopic common bile duct exploration, one case (1.4%) was converted to open operation and 2 cases (2.9%) developed postoperative bile leakage that was cured by conservative treatment. All patients recovered uneventfully. Conclusion: Using “three lines and one plane” as guidance for dissection of the extrahepatic bile ducts can avoid bile duct and vascular injury during laparoscopic surgery for bile duct stones. So, it is recommended to be used.


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引用

引用本文: 雷 汪, 辉 侯, 春利 吴, 宗繁 喻, 圣云 万. “三线一平面”解剖标记在腹腔镜胆道结石手术中的应用[J]. 中国普通外科杂志, 2016, 25(8): 1100-1104.
Cite this article as: WANG Lei, HOU Hui, WU Chunli, YU Zongfan, WAN Shengyun . Application of “three lines and one plane” as anatomic landmarks in laparoscopic surgery for bile duct stones [J]. Chin J Gen Surg, 2016, 25(8): 1100-1104.